Survey of influenza and other respiratory viruses diagnostic testing in US hospitals, 2012-2013.

BACKGROUND: Little is known about laboratory capacity to routinely diagnose influenza and other respiratory viruses at clinical laboratories and hospitals. AIMS: We sought to assess diagnostic practices for influenza and other respiratory virus in a survey of hospitals and laboratories participating in the US Influenza Hospitalization Surveillance Network in 2012-2013. MATERIALS AND METHODS: All hospitals and their associated laboratories participating in the Influenza Hospitalization Surveillance Network (FluSurv-NET) were included in this evaluation. The network covers more than 80 counties in 15 states, CA, CO, CT, GA, MD, MN, NM, NY, OR, TN, IA, MI, OH, RI, and UT, with a catchment population of ~28 million people. We administered a standardized questionnaire to key personnel, including infection control practitioners and laboratory departments, at each hospital through telephone interviews. RESULTS: Of the 240 participating laboratories, 67% relied only on commercially available rapid influenza diagnostic tests to diagnose influenza. Few reported the availability of molecular diagnostic assays for detection of influenza (26%) and other viral pathogens (≤20%) in hospitals and commercial laboratories. CONCLUSION: Reliance on insensitive assays to detect influenza may detract from optimal clinical management of influenza infections in hospitals.

Impact of Prompt Influenza Antiviral Treatment on Extended Care Needs After Influenza Hospitalization Among Community-Dwelling Older Adults.

BACKGROUND: Patients hospitalized with influenza may require extended care on discharge. We aimed to explore predictors for extended care needs and the potential mitigating effect of antiviral treatment among community-dwelling adults aged ≥ 65 years hospitalized with influenza. METHODS: We used laboratory-confirmed influenza hospitalizations from 3 influenza seasons. Extended care was defined as new placement in a skilled nursing home/long-term/rehabilitation facility on hospital discharge. We focused on those treated with antiviral agents to explore the effect of early treatment on extended care and hospital length of stay using logistic regression and competing risk survival analysis, accounting for time from illness onset to hospitalization. Treatment was categorized as early (≤ 4 days) or late (>4 days) in reference to date of illness onset. RESULTS: Among 6593 community-dwelling adults aged ≥ 65 years hospitalized for influenza, 18% required extended care at discharge. The need for care increased with age and neurologic disorders, intensive care unit admission, and pneumonia were predictors of care needs. Early treatment reduced the odds of extended care after hospital discharge for those hospitalized ≤ 2 or >2 days from illness onset (adjusted odds ratio, 0.38 [95% confidence interval {CI}, .17-.85] and 0.75 [.56-.97], respectively). Early treatment was also independently associated with reduction in length of stay for those hospitalized ≤ 2 days from illness onset (adjusted hazard ratio, 1.81; 95% CI, 1.43-2.30) or >2 days (1.30; 1.20-1.40). CONCLUSIONS: Prompt antiviral treatment decreases the impact of influenza on older adults through shorten hospitalization and reduced extended care needs.

Family History of Sudden Cardiac Death of the Young: Prevalence and Associated Factors.

Sudden cardiac death of the young (SCDY) is a devastating event for families and communities. Family history is a significant risk factor for this potentially preventable cause of death, however a complete and detailed family history is not commonly obtained during routine health maintenance visits. To estimate the proportion of adults with a family history of SCDY, the Michigan Department of Health and Human Services (MDHHS) Genomics Program included two questions within the 2007 Michigan Behavioral Risk Factor Survey (MiBRFS). Prevalence estimates and 95% confidence intervals were calculated. Among adults in Michigan, 6.3% reported a family history of SCDY, with a greater prevalence among blacks, those with lower household income, and those with less education. Among those reporting a family history of SCDY, 42.3% had at least one first-degree relative and 26.2% had multiple affected family members. This is the first study to demonstrate the prevalence of family history of SCDY while also highlighting key sociodemographic characteristics associated with increased prevalence. These findings should guide evidence-based interventions to reach those at greatest risk.

Comparing clinical characteristics between hospitalized adults with laboratory-confirmed influenza A and B virus infection.

We challenge the notion that influenza B is milder than influenza A by finding similar clinical characteristics between hospitalized adult influenza-cases. Among patients treated with oseltamivir, length of stay and mortality did not differ by type of virus infection.

The burden of influenza hospitalizations in infants from 2003 to 2012, United States.

BACKGROUND: Little information is available describing the epidemiology and clinical characteristics of those <12 months hospitalized with influenza, particularly at a population level. METHODS: We used population-based, laboratory-confirmed influenza hospitalization surveillance data from 2003 to 2012 seasons to describe the impact of influenza by age category (<3, 3 to <6 and 6 to <12 months). Logistic regression was used to explore risk factors for intensive care unit (ICU) admission. Adjusted age-specific, influenza-associated hospitalization rates were calculated and applied to the number of US infants to estimate national numbers of hospitalizations. RESULTS: Influenza was associated with an annual average of 6514 infant hospitalizations (range 1842-12,502). Hospitalization rates among infants <3 months were substantially higher than the rate in older infants. Most hospitalizations occurred in otherwise healthy infants (75%) among whom up to 10% were admitted to the ICU and up to 4% had respiratory failure. These proportions were 2-3 times higher in infants with high risk conditions. Infants <6 months were 40% more likely to be admitted to the ICU than older infants. Lung disease (adjusted odds ratio 1.80; 95% confidence interval 1.22-2.67), cardiovascular disease (adjusted odds ratio: 4.16; 95% confidence interval: 2.65-6.53), and neuromuscular disorder (adjusted odds ratio: 2.99; 95% confidence interval: 1.87-4.78) were risk factors for ICU admission among all infants. CONCLUSIONS: The impact of influenza on infants, particularly those very young or with high risk conditions, underscores the importance of influenza vaccination, especially among pregnant women and those in contact with young infants not eligible for vaccination.

Hospital-onset influenza hospitalizations--United States, 2010-2011.

BACKGROUND: Seasonal influenza is responsible for more than 200,000 hospitalizations each year in the United States. Although hospital-onset (HO) influenza contributes to morbidity and mortality among these patients, little is known about its overall epidemiology. OBJECTIVE: We describe patients with HO influenza in the United States during the 2010-2011 influenza season and compare them with community-onset (CO) cases to better understand factors associated with illness. METHODS: We identified laboratory-confirmed, influenza-related hospitalizations using the Influenza Hospitalization Surveillance Network (FluSurv-NET), a network that conducts population-based surveillance in 16 states. CO cases had laboratory confirmation ≤ 3 days after hospital admission; HO cases had laboratory confirmation > 3 days after admission. RESULTS: We identified 172 (2.8%) HO cases among a total of 6,171 influenza-positive hospitalizations. HO and CO cases did not differ by age (P = .22), sex (P = .29), or race (P = .25). Chronic medical conditions were more common in HO cases (89%) compared with CO cases (78%) (P < .01), and a greater proportion of HO cases (42%) than CO cases (17%) were admitted to the intensive care unit (P < .01). The median length of stay after influenza diagnosis of HO cases (7.5 days) was greater than that of CO cases (3 days) (P < .01). CONCLUSION: HO cases had greater length of stay and were more likely to be admitted to the intensive care unit or die compared with CO cases. HO influenza may play a role in the clinical outcome of hospitalized patients, particularly among those with chronic medical conditions.

Patients hospitalized with laboratory-confirmed influenza during the 2010-2011 influenza season: exploring disease severity by virus type and subtype.

BACKGROUND: The 2010-2011 influenza season was dominated by influenza A(H3N2) virus, but influenza A(H1N1) pdm09 (pH1N1) and B viruses cocirculated. This provided an opportunity to explore within-season predictors of severity among hospitalized patients, avoiding biases associated with season-to-season differences in strain virulence, population immunity, and healthcare seeking. METHODS: Population-based, laboratory-confirmed influenza hospitalization surveillance data were used to examine the association between virus type/subtype and outcomes in children and adults. Multivariable analysis explored virus type/subtype, prompt antiviral treatment, medical conditions, and age as predictors for severity (intensive care unit admission or death). RESULTS: In children, pH1N1 (adjusted odds ratio [aOR], 2.19; 95% confidence interval [CI], 1.11-4.3), chronic metabolic disease (aOR, 5.23; 95% CI, 1.74-15.69), and neuromuscular disorder (aOR, 4.84; 95% CI, 2.02-11.58) were independently associated with severity. In adults, independent predictors were pH1N1 (aOR, 2.21; 95% CI, 1.66-2.94), chronic lung disease (aOR, 1.46, 95% CI, 1.12-1.89), and neuromuscular disorder (aOR, 1.68; 95% CI, 1.11-2.52).Antiviral treatment reduced the odds of severity among adults (aOR, 0.47; 95% CI, .33-.68). CONCLUSIONS: During the 2010-2011 season, pH1N1 caused more severe disease than H3N2 or B in hospitalized patients. Underlying medical conditions increased severity despite virus strain. Antiviral treatment reduced severity among adults. Our findings underscore the importance of influenza prevention.

Reduced influenza antiviral treatment among children and adults hospitalized with laboratory-confirmed influenza infection in the year after the 2009 pandemic.

Influenza antiviral treatment is recommended for all persons hospitalized with influenza virus infection. During the 2010-2011 influenza season, antiviral treatment of children and adults hospitalized with laboratory-confirmed influenza declined significantly compared with treatment during the 2009 pandemic (children, 56% vs 77%; adults, 77% vs 82%; both P < .01).

Rubella contact tracing associated with air travel.

This report reviews U.S. guidelines for the identification of persons exposed to rubella during air travel. In response to an individual with rubella who traveled on multiple flights, CDC conducted an airline contact investigation that was expanded beyond customary protocol to assess if current operating procedures are adequate. Of 250 potentially exposed airline passengers, 215 (86%) were contacted and none developed a rubella-like rash, arguing against the need to notify passengers beyond the standard protocol in most cases.

Attitudes and behaviors of international air travelers toward pandemic influenza.

BACKGROUND: Air travelers play a significant role in the spread of novel strains of influenza viruses; however, little is understood about the knowledge, attitudes, and practices of international air travelers toward pandemic influenza in relation to public health interventions and personal protective behaviors at overseas destinations. METHODS: Prior to the 2009 H1N1 influenza pandemic, we surveyed a convenience sample of 404 departing international travelers at Detroit Metropolitan Wayne County Airport. Presented with a hypothetical pandemic influenza scenario occurring overseas, the participants predicted their anticipated protective behaviors while abroad and recorded their attitudes toward potential screening measures at US ports of entry (POE). The survey also qualitatively explored factors that would influence compliance with health entry screening at POE. RESULTS: Those who perceived pandemic influenza to be serious were more likely to state that they would be comfortable with screening (p = 0.006), and if they had influenza-like illness (ILI) overseas, would be more willing to see a physician and delay return travel (p = 0.006 and 0.002, respectively). Other demographic variables, including age and race, were associated with protective behaviors in response to ILI. Travelers also identified diverse information requirements which would influence their behavior in response to entry screening, including characteristics of the pandemic, severity of illness, and screening operations. CONCLUSIONS: Demographic characteristics and perceived severity of illness are important factors that may influence the protective behaviors of travelers overseas. Our results indicate that educational material and advice directed to international travelers could be differentially tailored to traveler subpopulations.

Screening for testicular cancer: an evidence review for the U.S. Preventive Services Task Force.

BACKGROUND: Testicular cancer is the most common type of cancer in men aged 15 to 34 years. Because treatment produces favorable outcomes even in advanced stages, the U.S. Preventive Services Task Force (USPSTF) concluded in 2004 that screening asymptomatic men for testicular cancer is unlikely to produce additional benefits over clinical detection. PURPOSE: To search for new evidence on the benefits and harms of screening for testicular cancer to assist the USPSTF in updating its 2004 recommendation. DATA SOURCES: English-language articles indexed in PubMed and the Cochrane Library and published between 1 January 2001 and 11 November 2009. STUDY SELECTION: Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; and case-control studies were selected to determine the benefits of screening for testicular cancer. Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; case-control studies; and case series of large, multisite databases were selected to determine the harms of screening. Each author independently reviewed titles, abstracts, and full-text articles for possible inclusion. DATA EXTRACTION: One author abstracted information on the benefits and harms of screening for testicular cancer. DATA SYNTHESIS: No studies met the inclusion criteria. Three studies were considered for inclusion at the full-text stage of review. These inconclusive studies addressed testicular microlithiasis, XIST gene testing, and testis-sparing surgery. LIMITATION: The focused search strategy may have missed some smaller studies or studies published in languages other than English on the benefits or harms of testicular cancer screening. CONCLUSION: No new evidence was found on the benefits or harms of screening for testicular cancer that would affect the USPSTF's previous recommendation against screening.